Comparison of radioguided occult lesion localization (ROLL) and wire localization for non‐palpable breast cancers: A meta‐analysis

Sajid, Muhammad Shafique; Parampalli, Umesh; Haider, Zishan; Bonomi, Ricardo

doi:10.1002/jso.23016

Cited by 123 publications

(74 citation statements)

References 51 publications

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“…The oriantation of the surgeon on macroscopic margins is difficult if there is trouble in determining the depth and localization of the lesion. In centers where this approach has been employed as a definitive therapeutic procedure, 41-60% of patients require no further local surgery, which results in lower costs and morbidity (Saarela et al, 2001;Ocal et al, 2011;Sajid et al, 2012). However, as there is heterogeneity of study designs and endpoints as well as small study sample sizes in literature, the range of the rates vary so widely.…”

Section: Discussionmentioning

confidence: 99%

Wire-guided Localization Biopsy to Determine Surgical Margin Status in Patients with Non-palpable Suspicious Breast Lesions

Doğan¹,

Gülçelik²,

Yuksel³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Purpose: Guide-wire localization (GWL) has been a standard technique for many years. Excision of nonpalpable malignant breast lesions with clear surgical margins reduces the risk of undergoing re-excision. The objective of the present study was to evaluate the efficacy of GWL biopsy for assessing surgical margins. Methods: This retrospective study concerned 53 patients who underwent GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. Results: Median age was 53.3 years, median tumour size was 1.5 cm and median specimen volume was 71.5 cm 3 . In fifteen patients (28%) DCIS and in 38 patients (72%) invasive ductal carcinoma was diagnosed. There was positive surgical margins in twenty eight (52.8%) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant factors for surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p=0.04). 79% of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification as compared to 48% in the patients who had negative margins (p=0.03). Some 38 patients who had positive or close surgical margins received re-excision (72%). Conclusion: Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.

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Section: Discussionmentioning

confidence: 99%

Wire-guided Localization Biopsy to Determine Surgical Margin Status in Patients with Non-palpable Suspicious Breast Lesions

Doğan¹,

Gülçelik²,

Yuksel³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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“…121,122 Imagedirected localization of nonpalpable breast lesions is necessary to perform breast-conserving procedures.…”

Section: Evolving Technologies With Implications Formentioning

confidence: 99%

New Developments in Breast Cancer and Their Impact on Daily Practice in Pathology

Li¹,

Oprea‐Ilies²,

Krishnamurti

2017

Archives of Pathology &Amp; Laboratory Medicine

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Advances in research have transformed our understanding of breast cancers and have altered the daily practice of pathology. Theranostic evaluations performed by pathologists are now critical in triaging the patients into appropriate treatment groups, as are new guidelines that were recently established for the evaluation of HER2/neu gene amplification. Emerging molecular classifications of breast cancers bring novel perspectives to the assessment of individual cases, and opportunities for better treatments. Molecular studies have particularly shed light on distinct biological subsets of triple-negative breast cancers, for which new targeted therapies are being developed. The prognostic and therapeutic utility of new histopathologic parameters, such as tumor-infiltrating lymphocytes, are also being elucidated, and new protocols have been devised for the pathologic evaluation of breast specimens that have undergone neoadjuvant treatment. Novel clinical practices, such as radioactive seed localization, also affect the way breast specimens are processed and evaluated. In this brief review, we highlight the developments that are most relevant to pathology and are changing or could potentially impact our daily practice.

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“…The current accepted standard of treatment for non-palpable breast cancers of wire-guided localization (WGL) has been increasingly challenged by radio-guided localization (RGL) techniques in the form of radio-guided occult lesion localization (ROLL) and radio-guided seed localization (RSL). In the four meta-analyses of RGL versus WGL, [2][3][4][5] three have demonstrated the superiority of RGL [2,4,5] with the remaining study demonstrating shorter operating times but also greater volume excisions for RGL [3]. However, the clinical relevance of this greater volume of excision remains questionable [6].…”

mentioning

confidence: 99%

“…Level I evidence from meta-analyses exists to support the use of RGL in the treatment of non-palpable breast cancer [2][3][4][5]. This evidence has accumulated over the last 15 years since the first publication of the ROLL technique [9].…”

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confidence: 99%

ROLL versus RSL: toss of a coin?

Ahmed

Douek

2013

Breast Cancer Res Treat

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The safety and benefits of radio-guided localization (RGL) versus wire-guided localization (WGL) surgery in the treatment of non-palpable breast cancers have been confirmed through several meta-analyses. RGL has become the standard of care in several institutions, although overall uptake has been slow. In view of this evidence supporting RGL, we believe that the future discussion is not of RGL versus WGL, but rather of what form of RGL will constitute best practice of care going forward. We therefore discuss the case for radio-guided occult lesion localization versus radioactive seed localization in the treatment of non-palpable breast cancers, is it really a toss of a coin?Keywords Wire-guided localization Á Radio-guided occult lesion localization Á ROLL Á Radioactive seed localization Á RSL Á Radio-guided localization Á Non-palpable breast cancer Non-palpable breast cancers constitute approximately onethird of all diagnosed breast cancers, [1] therefore creating a heavy burden upon health care systems. The current accepted standard of treatment for non-palpable breast cancers of wire-guided localization (WGL) has been increasingly challenged by radio-guided localization (RGL) techniques in the form of radio-guided occult lesion localization (ROLL) and radio-guided seed localization (RSL). In the four meta-analyses of RGL versus WGL, [2][3][4][5] three have demonstrated the superiority of RGL [2,4,5] with the remaining study demonstrating shorter operating times but also greater volume excisions for RGL [3]. However, the clinical relevance of this greater volume of excision remains questionable [6]. The two largest cohort series [7-9] each composed of approximately 1,000 patients supports the excellent outcomes achievable with RGL. The economical assessment has also demonstrated no disadvantage for RGL [7,[9][10][11]. In view of the mounting evidence supporting RGL, the question no longer remains that of the previous decade in terms of deciding between RGL and WGL, but rather the clinically relevant issue has now progressed to deciding between ROLL and RSL in the treatment of non-palpable breast cancers.Both techniques depend upon the presence of a skilled radiologist to perform either ultrasound or stereotactically guided localization, with the administration of between 0.2 and 0.5 mL of 99m Tc-radiolabelled albumin-based colloid for ROLL or a single 8 9 0.4 mm titanium seed radiolabelled with 125 I in RSL. Great variation exists in the radiation dose administered for ROLL, with the literature quoting anywhere between 5 and 123 MBq, [12,13] whilst for RSL it is between 3.7 and 10.7 MBq [14,15]. ROLL requires localization to be performed within 24 h of surgery due to the short 6 h half-life of 99m Tc-labelled colloid and RSL typically is performed 0-5 days prior to surgery [7,[14][15][16][17]. In the primary systemic therapy (PST) setting RSL can be undertaken several months before surgery because the half-life of 125 I is 60 days [18]. This flexibility in the timing of seed insertion provides a clear ...

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Comparison of radioguided occult lesion localization (ROLL) and wire localization for non‐palpable breast cancers: A meta‐analysis

Cited by 123 publications

References 51 publications

Wire-guided Localization Biopsy to Determine Surgical Margin Status in Patients with Non-palpable Suspicious Breast Lesions

Wire-guided Localization Biopsy to Determine Surgical Margin Status in Patients with Non-palpable Suspicious Breast Lesions

New Developments in Breast Cancer and Their Impact on Daily Practice in Pathology

ROLL versus RSL: toss of a coin?

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